Non-technical skills of anaesthesia providers in Rwanda: an ethnography

Introduction: Patient safety depends on excellent practice of anaesthetists’ non-technical skills (ANTS). The ANTS framework has been validated in developed countries but there is no literature on the practice of ANTS in low-income countries. This study examines ANTS in this unexplored context. Methods: This qualitative ethnographic study used observations of Rwandan anaesthesia providers and  in-depth interviews with both North American and Rwandan anaesthesia providers to understand practice of ANTS in Rwanda. Results: Communication is central to the practice of ANTS. Cultural factors in Rwanda, such as lack of  assertiveness and discomfort taking leadership, and the strains of working in a resourcelimited environment hinder the unfettered and focused communication needed for excellent anaesthesia practice. Conclusion: Despite the challenges, anaesthesia providers are able to coordinate activities when good  communication is actively encouraged. Future teaching interventions should address leadership and  communication skills through encouraging both role definition and speaking up for patient safety.Key words: Anaesthesia, non-technical skills, genocid

Development of a simulation and skills centre in East Africa: a Rwandan-Canadian partnership

Simulation replicates clinical experiences without patient risk; it remains uncommon in lower-income  countries. We outline the creation of Rwanda's first centre for simulation and skills training. We secured  funding for renovations, equipment and staff; curricula were developed, tested, and refined; local clinicians were trained to teach. In 13 months the centre provided 2,377 learning-encounters and 822 hours of training to Rwandan health care professionals. Our strategy represents an adaptable model for simulation and skills centre development in low-resources settingsKey words: Simulation, Medical Education, Rwanda, Low-Income Countr

Электропривод и электрооборудование механизма подъема экскаватора ЭШ 20/90

Произведен расчёт и выбор силового оборудования для электропривода механизма подъема одноковшового экскаватора ЭШ 20/90. Исследованы статические и динамические характеристики двухконтурной системы автоматического регулирования электропривода экскаватора.The calculation and choice of power equipment for the electric drive of the lifting mechanism of the one-bucket excavator ES 20/90 is made. The static and dynamic characteristics of a two-circuit automatic control system for the electric drive of an excavator are studied

Lung-protective ventilation attenuates mechanical injury while hypercapnia attenuates biological injury in a rat model of ventilator-associated lung injury

$\textbf {Background and Objective:}$ Lung-protective mechanical ventilation is known to attenuate ventilator-associated lung injury (VALI), but often at the expense of hypoventilation and hypercapnia. It remains unclear whether the main mechanism by which VALI is attenuated is a product of limiting mechanical forces to the lung during ventilation, or a direct biological effect of hypercapnia. $\bf Methods:$ Acute lung injury (ALI) was induced in 60 anesthetized rats by the instillation of 1.25 M HCl into the lungs via tracheostomy. Ten rats each were randomly assigned to one of six experimental groups and ventilated for 4 h with: 1) \textbf {Conventional \(HighV_{E} Normocapnia}\) (high $V_{T}$, high minute ventilation, normocapnia), 2) $\textbf {Conventional Normocapnia}$ (high $V_{T}$, normocapnia), 3) $\textbf {Protective Normocapnia}$ ($V_{T}$ 8 ml/kg, high RR), 4) \textbf {Conventional \(iCO_{2} Hypercapnia}\) (high $V_{T}$, low RR, inhaled $CO_{2}$), 5) \textbf {Protective \(iCO_{2} Hypercapnia}\) ($V_{T}$ 8 ml/kg, high RR, added $CO_{2}$), 6) $\textbf {Protective endogenous Hypercapnia}$ ($V_{T}$ 8 ml/kg, low RR). Blood gasses, broncho-alveolar lavage fluid (BALF), and tissue specimens were collected and analyzed for histologic and biologic lung injury assessment. $\bf Results:$ Mild ALI was achieved in all groups characterized by a decreased mean $PaO_{2}/FiO_{2}$ ratio from 428 to 242 mmHg ($\it p$ < 0.05), and an increased mean elastance from 2.46 to 4.32 $cmH_{2}O$/L ($\it p$ < 0.0001). There were no differences in gas exchange among groups. Wet-to-dry ratios and formation of hyaline membranes were significantly lower in low $V_{T}$ groups compared to conventional tidal volumes. Hypercapnia reduced diffuse alveolar damage and IL-6 levels in the BALF, which was also true when $CO_{2}$ was added to conventional $V_{T}$. In low $V_{T}$ groups, hypercapnia did not induce any further protective effect except increasing pulmonary IL-10 in the BALF. No differences in lung injury were observed when hypercapnia was induced by adding $CO_{2}$ or decreasing minute ventilation, although permissive hypercapnia decreased the pH significantly and decreased liver histologic injury. $\bf Conclusion:$ Our findings suggest that low tidal volume ventilation likely attenuates VALI by limiting mechanical damage to the lung, while hypercapnia attenuates VALI by limiting pro-inflammatory and biochemical mechanisms of injury. When combined, both lung-protective ventilation and hypercapnia have the potential to exert an synergistic effect for the prevention of VALI